Vanderbilt University Medical Center, Nashville, Tennessee.
Panel Chair, Duke University, Durham, North Carolina.
J Am Coll Radiol. 2023 May;20(5S):S94-S101. doi: 10.1016/j.jacr.2023.02.014.
Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
肺癌仍然是美国男性和女性癌症相关死亡的主要原因。用年度低剂量 CT 筛查肺癌可以挽救生命，而持续进行肺癌筛查可以挽救更多生命。2015 年，CMS 开始根据最初的美国预防服务工作组（USPSTF）肺癌筛查标准，为符合条件的人提供年度肺癌筛查，这些标准包括年龄在 55 至 77 岁之间、有 30 包年吸烟史的人，目前正在使用烟草或在过去 15 年内吸烟。2021 年，USPSTF 发布了新的筛查指南，将符合条件的年龄降低到 80 岁，吸烟包年数降低到 20 年。对于那些不符合更新后的 USPSTF 标准但有肺癌发展额外风险因素的人，肺癌筛查仍然存在争议。美国放射学院适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订过程支持对同行评议期刊上的医学文献进行系统分析。既定的方法学原则，如推荐评估、制定和评估分级或 GRADE，适用于评估证据。RAND/UCLA 适宜性方法用户手册提供了用于确定特定临床情况下影像学和治疗程序适宜性的方法。在缺乏或模棱两可的同行评议文献的情况下，专家可能是制定建议的主要证据来源。
